Leadership and the future of nursing

There’s a growing call for nurses to make their voices heard in public life, to stand up for the disadvantaged and for the future of the profession.  

"As a profession, it’s up to all of us to think about how we want to practise in the future. Let’s set ourselves ambitious goals. Just maybe the barrier of most significance is that we’re not dreaming big enough."

Anna Groth is a leader of the future and exactly what Australian nursing is looking for. As one of five winners in the prestigious Australian College of Nursing’s Emerging Nurse Leader Program, the second year James Cook University student from the school of Nursing, Midwifery and Nutrition is a determined young woman.

“I was lucky to be raised in a multicultural part of Sydney where I was exposed to refugees and students from poor backgrounds,” she says. “I felt privileged to grow up in a family where I had an easy upbringing and I became determined to get involved in helping others.

“What I’ve witnessed at James Cook is first generation students from poor backgrounds who are here to study and get ahead.

“I’m really keen to promote the field of nursing as one that offers great opportunities and can make a difference. I really think the degree needs to be better marketed.”

Groth and fellow James Cook University nursing student Evan Casella, who was also an ACN Emerging Nurse Leader Program winner, have worked together on programs for AusAid this year and will continue to work with programs associated with the World Health Organisation.

Nursing is in great need of leaders to take the initiative and students like Groth and Casella are exactly what the industry needs.

“We need leaders,” Linda Shields, professor of nursing, tropical health at James Cook University says. “We need to develop young talent.

“Nursing needs to be recognised for the wonderful profession it is. Australian nurses are without a doubt among the best in the world and I can personally attest to this having worked abroad for many years.”

Shields believes that nurses need to gain overseas experience in order to comprehend how other systems work and realise that Australia has a very good system of training in place for nurses.

“In every profession, you have people who want to progress their career and those that don’t,” she says. “I believe schools of nursing here in Australia foster outstanding young leaders who embrace career progression and make a difference to our clinical and patient care.

“But we have to be careful, given government cuts in the area of health, that we don’t stymie career advancement. We have to ensure that the role of the nurse stays true to its foundation.”

Shields focuses on two main areas of research and scholarship – paediatric and child health nursing, and history. In those areas she investigates, in the main, family-centred care, how vulnerable families seek healthcare for their children and the health of children in developing countries.

“There are many career opportunities for nurses but I think it would be great if more nurses were inclined to enter parliament and senior public service roles,” she says.

“If they could undertake these roles without leaving the nursing profession it would be a real boon. I really think at a university level we need to encourage nurses to become more vocally active in politics.”

According to the Australian Health Practitioner Regulation Agency, Australia had 342,802 practising nurses as of June 2013. There are a further 3873 non-practising nurses, whose services may be called upon as the impending nursing shortage looms.

The majority of these nurses stay in the primary area of healthcare, but fortunately some, such as Catherine Stoddart, take the initiative to enter public service in order to make a difference.

Stoddart is the chief nurse and midwifery officer for the Western Australian Department of Health and an adjunct associate professor.

She won the award of Telstra Business Woman of the Year in 2011 when she was recognised for building stronger nursing career paths and attracting more Aboriginal people to the profession.

She has also played a major part in creating nurse practitioner positions in rural areas and providing volunteers for underserviced remote and international locations.

“When you stop and think about it, a typical hospital ward is really a multi-million dollar business,” Stoddart says. “By the time you factor in the number patients treated and their consumables, the wages and scheduling of staff and the number of dependent services that all rely on the smooth running of a ward, it’s huge. With lives and wellbeing at stake, the leadership of such a unit is way too important to leave to chance.

“In WA we believe that for nursing and midwifery, great care is our business. Great care – not just good care – that’s delivered in a safe, reliable, cost-effective way doesn’t happen by accident. That’s why health departments across Australia and elsewhere are increasingly investing in leadership and management skills for frontline nurses and midwives.”

Stoddart has a plethora of tertiary qualifications along with having been a Nuffield fellow (in 2000) and Churchill fellow (2006), which allowed her to review models for isolated nursing practice in Alaska and Canada, focusing on indigenous communities. She has also participated in several health reform projects at a national level to improve reform of elective surgery.

“Earlier in my career, I had the wonderful opportunity to work briefly in a developing country as well as in a number of isolated communities in Australia,” she says. “These were life-changing moments for me and certainly ignited my passion for global and local health initiatives that focus on improving health outcomes for the disadvantaged.

“Indelible experiences like these and many others have driven me to study, to pursue challenging goals and to hone my ability to influence so that I can play a part in making things better for the generation of nurses and midwives to come. This includes expanding the scope and practice settings where future nurses and midwives can do their best work and to the maximum benefit of the community.”

Western Australia Health has invested in creating a range of leadership programs such as the Leading Great Care program, where students receive a graduate certificate in nursing leadership and management from the University of Notre Dame. It also launched an inaugural nursing and midwifery leadership conference as a means to showcase and encourage attendees to consider leadership roles.

“Furthermore,” Stoddart says, “our current leaders need to be generous and to encourage more junior staff by sharing their knowledge and skills and by casting the net of encouragement wide – to include those quiet achievers who otherwise are often missed when considering acting-up opportunities. This will ensure that succession is planned rather than left to last.

“We are authors of our own destiny. As a profession, it’s up to all of us to think about how we want to practise in the future. Let’s set ourselves ambitious goals. Just maybe the barrier of most significance is that we’re not dreaming big enough.

“Personally, I’d like to see nurses become the go-to health professional for initial healthcare services, particularly in primary health, chronic health and migrant health.”

Another high achiever in the nursing profession is Alison McMillan, the chief nurse and midwifery officer for the Victorian Department of Health. Her role is highly diversified and involves, among other duties, providing nursing and midwifery leadership to the sector.

“Nursing leadership has always been important but more so now than ever because of the diminishing workforce combined with the increasing complexity of work because of our ageing population,” she says.

“As the population ages, we’re seeing more people with multiple illnesses and that increases the complexity of the role of the nurse. The breakdown of the nuclear family has also brought a need for more social input from the nurse.”

McMillan says her aim is to improve the system and she has worked alongside nurses and midwives in emergency to get a first hand look at the pressures they face and how the system operates.

“I think part of the problem is that nurses are generally forced to take on just one role while some other sectors of the medical profession can take on multiple roles,” she says. “We need to allow nurses to be able to practise, to teach, to lead, to be a manager and we even need to change the workplace set-up.

“I think we need to analyse other professions to assess how we can set up jobs differently. In essence, nursing is a female-oriented profession and a lot of women are juggling families, career and children, which is very tricky.

“We need to set up the system so that nurses can find a balance and this goes way beyond job share. Nurses can contribute a lot more than they’re doing and although many nurses are natural leaders I think leadership needs to be taught at undergraduate level.

“If universities can add leadership skills to their undergraduate and post-graduate studies then this will definitely add to the number of nurses who seek leadership positions upon gaining relevant work experience.”

Another high achiever, Susan Pearce, who is chief nursing and midwifery officer for the NSW Department of Health, regularly spends a day at the frontline of nursing to keep in touch with the demands of the profession.

“Every couple of months I don the uniform and work where needed,” she says. “It enables me to make better decisions regarding the profession when I see it at the coalface.”

Pearce provides the professional link between the NSW minister for health, the director-general of the ministry of health and the public, private and educational sectors of the nursing and midwifery professions in NSW.

“We develop highly technical skills for nurses to ensure that our patients get good care,” she says. “It’s important that nurses and midwifery have a voice. The key is to make our workplace better for everyone.

“I think nurses need to ask where they want to go with their profession. A lot of money is invested in training nurses; there are a lot of complex roles in the profession and nurses are generally focused on improving their skills and knowledge.”

Professor Jill White, dean of nursing at the University of Sydney, says the complexity and stress of nursing sometimes makes it hard for nurses to think ahead to career progression.

“Where the nurse is working will affect their view of their future career,” she says. “For example, if you’re working in a hospital that’s understaffed, then it’s just a matter of going through your shift on most days.

“I think we need to take a helicopter view of the profession and of healthcare overall, so we can work out what skill mix we need. How many nurses do we need with masters degrees? How many with PhDs? I really think we need to link career progression with education rather than industrial awards.

“Gone are the days of just studying for your degree and that’s it. Nurses will continue to learn and develop and we need them to showcase their skillset outside the profession so that people can fully appreciate and understand the roles they perform.”

Do you have an idea for a story?
Email [email protected]